US10695543B2 - Methods for treating cancerous tumors - Google Patents

Methods for treating cancerous tumors Download PDF

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US10695543B2
US10695543B2 US15/807,011 US201715807011A US10695543B2 US 10695543 B2 US10695543 B2 US 10695543B2 US 201715807011 A US201715807011 A US 201715807011A US 10695543 B2 US10695543 B2 US 10695543B2
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tumor
agent
radiation
target area
dose
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US20180333563A1 (en
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Ramtin Agah
Kamran Najmabadi
Shaun R. BAGAI
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RenovoRx Inc
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RenovoRx Inc
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Priority to US15/807,011 priority Critical patent/US10695543B2/en
Priority to JP2020514151A priority patent/JP2020520992A/ja
Priority to EP18731590.8A priority patent/EP3624794A1/en
Priority to PCT/US2018/033482 priority patent/WO2018213760A1/en
Priority to CN201880003352.9A priority patent/CN109982698A/zh
Publication of US20180333563A1 publication Critical patent/US20180333563A1/en
Assigned to RENOVORX, INC. reassignment RENOVORX, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: AGAH, RAMTIN, BAGAI, SHAUN, NAJMABADI, KAMRAN
Assigned to RENOVORX, INC. reassignment RENOVORX, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: AGAH, RAMTIN, BAGAI, SHAUN, NAJMABADI, KAMRAN
Priority to US16/685,974 priority patent/US11052224B2/en
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Priority to US17/315,220 priority patent/US12290564B2/en
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Definitions

  • Solid tumors are masses of abnormal tissue that originate in organs or soft tissues that typically do not include fluid areas. Some examples of solid tumors include: pancreatic cancer, lung cancer, brain cancer, liver cancer, uterine cancer, and colon cancer.
  • Surgical resection involves the removal of tumor tissue. Radiation uses beams of intense energy to kill cancer cells and to shrink tumors. And chemotherapy involves the use of therapeutic agents or drugs to treat cancer. But surgical resection may not completely remove a tumor. Radiation and chemotherapy can have undesirable systemic side effects, including extreme fatigue, hair loss, infection, nausea and vomiting, and others that limit their usefulness. More recently, direct activation of the patient's immune system to attack cancerous cells has shown promise in treating certain solid tumors, but not all. Thus, the need for an improvement in both the safety and the efficacy of current therapy still exists.
  • TAC or TACE can involve imaging an organ having a tumor using angiography, isolating a branch of the artery that feeds the tumor or portion of the organ containing the tumor, and then locally injecting chemotherapy in a bolus fashion via the isolated artery.
  • Localized intra-arterial therapies allow higher drug concentration to reach the tumor, overcoming the problem of poor blood flow to tumor mass in comparison to healthy tissue.
  • localized intra-arterial therapies can also take advantage of the first pass effect of chemotherapeutics by generating higher level drug concentrations at the tumor cell membrane and therefore enhancing cellular drug uptake as compared to non-localized infusion.
  • local delivery can reduce systemic side effects of chemotherapy.
  • TAC and TACE One of the limitations of TAC and TACE is the need for selective cannulation and isolation of the tumor feeder vessel or arterial branch that can target the smallest portion of the organ containing the tumor. But it may be difficult to target and limit drug delivery to a small portion of the organ containing the tumor while achieving desired efficacy levels with the cancer treatment. On the one hand, limiting drug delivery to a small portion of the organ can reduce the potential impact of the administered drug on surrounding healthy tissue. But on the other hand, when the isolated region becomes too small, drug uptake levels by the tumor may decrease and reduce the efficacy of the cancer treatment. Given these limitations, a method to deliver a sufficient dose of a chemotherapeutic drug in addition to and independent of the need to cannulate and isolate to a specific feeding/supplying branch of a tumor feeder vessel is highly desirable.
  • pancreatic cancer ranked as the fourth leading cause of cancer death in the United States, and the tenth most commonly diagnosed tumor type in men and women.
  • Estimates of incidence and deaths caused by pancreatic cancer are approximately 53,070 and 41,780, respectively (American Cancer Society: Cancer Facts and Figures, American Cancer Society, 2016). Projections based on the changing demographics of the United States population and changes in incidence and death rates reveal that, unless earlier diagnosis is made possible or better treatment options become available, pancreatic cancer is anticipated to move from the fourth to the second leading cause of cancer death in the United States by 2020.
  • Systemic chemotherapy as treatment for pancreatic cancer may be modestly effective due to low drug penetration in the pancreas because a drug infused systemically only moderately penetrates the pancreas, which may generally increase toxicity within a patient's body but not have an effect on the cancer.
  • tumors located in the pancreas are located in tissue surrounding an artery but not in a region of an artery that can be targeted and isolated. Accordingly, it may be difficult for a biologic agent or drug to reach and treat the tumors.
  • drug delivery to pancreatic tumors is especially difficult due to the hypo-vascular and poorly perfused nature of the pancreas.
  • pancreas lends itself to reduced drug levels within the organ tissue, which reduces the effectiveness of systemic chemotherapy that relies on a functional vasculature for delivery to tumor cells. Also, the effect of chemotherapy is concentration dependent, and systemic infusion oftentimes results in low concentrations. Aside from dosing limitations in treating pancreatic cancer, many systemic side effects of chemotherapeutic agents can result from the treatment.
  • Lung cancer is another deadly cancer that is difficult to treat. Lung cancer is responsible for 23% of total cancer deaths. Long-term exposure to tobacco smoke causes 80 to 90% of lung cancers. Nonsmokers account for 10 to 15% of lung cancer cases, and these cases are often attributed to a combination of genetic factors or other environmental exposures (Vogl, T. J., et al., Seminars in Interventional Radiology, 2013, 30(2): 176-184).
  • lung cancer Common treatments for lung cancer depend on the cancer's specific pathology, staging, and the patient's performance status (e.g., ability to breath). Traditional treatment options are surgery, chemotherapy, immunotherapy, radiation therapy, and palliative care. Intravascular techniques for localized delivery of chemotherapeutic agents have also been used to treat lung cancer, and include cancer therapy such as arterial chemoembolization, bronchial artery infusion (BAI), isolated lung perfusion (ILP), and lung suffusion.
  • BAI bronchial artery infusion
  • IPP isolated lung perfusion
  • Chemotherapeutics approved for the treatment of non-small cell lung cancer in the United States include methotrexate, paclitaxel albumin-stabilized nanoparticle formulation, afatinib dimaleate, everolimus, alectinib, pemetrexed di sodium, atezolizumab, bevacizumab, carboplatin, ceritinib, crizotinib, ramucirumab, docetaxel, erlotinib hydrochloride, gefitinib, afatinib dimaleate, gemcitabine hydrochloride, pembrolizumab, mechlorethamine hydrochloride, methotrexate, vinorelbine tartrate, necitumumab, nivolumab, paclitaxel, ramucirumab, and osimertinib, and the combinations carboplatin-taxol and gemcitabine-ci splatin (https://www.cancer.gov
  • Drugs approved for the treatment of small cell lung cancer include methotrexate, everolimus, doxorubicin hydrochloride, etoposide phosphate, topotecan hydrochloride, mechlorethamine hydrochloride, and topotecan (https://www.cancer.gov/aboutcancer).
  • Lung cancer such as small cell lung cancer can sometimes be treated with a combination of radiation therapy and one or more chemotherapeutics. But other types of lung cancer such as non-small cell lung cancer may not be sensitive to current chemotherapeutics. In many instances, current treatment methods are not effective at providing meaningful treatment or palliative care. Thus, it is desirable to have a more effective method for treating lung cancer tumors.
  • Malignant gliomas comprise up to 80% of primary malignant brain tumors in the adults. Among these, glioblastomas are the most deadly and account for 82% of all malignant gliomas (Suryadevra, C. M., et al., Surg. Neurol. Int., 2015, 6(1):S68-S77).
  • the current standard of care includes surgical resection, followed by adjuvant external beam radiation and chemotherapy with drugs such as temozolomide.
  • Conventional therapy is nonspecific and often results in a tragic destruction of healthy brain tissue. These treatments can be incapacitating and produce a median overall survival of just twelve to fifteen months.
  • glioblastomas are also highly vascularized tumors, and their unique capacities for regulating angiogenesis contribute to their resistance against known therapies.
  • gliomas including glioblastoma multiforme
  • a catheter is inserted in the femoral artery and ends in the carotid artery, while a separate microcatheter is also inserted into the femoral artery and used to explore the specific vessels feeding the tumor for administration of the chemotherapy (Burkhardt, J-K., et al., Interventional Radiology, 2011, 17:286-295). But such methods are not always effective and can be improved.
  • Liver cancer is another difficult-to-treat cancer characterized by solid tumors.
  • an estimated 39,230 adults (28,410 men and 10,820 women) in the United States will be diagnosed with primary liver cancer. Liver cancer also commonly metastasizes to other parts of the body. It is estimated that 27,170 deaths (18,280 men and 8,890 women) from this disease will occur this year.
  • Liver cancer is the tenth most common cancer and the fifth most common cause of cancer death among men. It is also the eighth most common cause of cancer death among women (American Cancer Society: Cancer Facts and Figures, American Cancer Society, 2016).
  • liver cancer is much more common in developing countries within Africa and East Asia. In some countries, it is the most common cancer type.
  • the one-year survival rate for people with liver cancer is 44%.
  • the five-year survival rate is 17%.
  • the five-year survival rate is 31%, while it is only 11% if the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes. If the cancer has spread to a distant part of the body, the 5-year survival rate is only 3% (http://www.cancer.net/cancer-types/liver-cancer/statistics).
  • a thick, oily substance for example, Lipiodol
  • chemotherapy for example, floxuridine, sorafenib tosylate or a mixture of platinol, mitomycin, and adriamycin
  • the Lipiodol, or other particles helps to contain the chemotherapy within the tumor and blocks further blood flow, thus cutting off the tumor's food and oxygen supply.
  • TACE with doxorubicin-filled beads delivers the beads directly to the liver, which releases chemotherapy slowly over time and also blocks the blood flow to the tumor.
  • radioactive yttrium beads are delivered via a catheter into the hepatic artery.
  • the beads deliver radiation to the tumor, which kills the tumor cells, although other unintended areas of the liver may also receive radiation, creating undesirable destruction of healthy tissue.
  • CCRT Concurrent chemoradiotherapy
  • NAC Neoadjuvant chemotherapy
  • IANAC Neoadjuvant intra-arterial chemotherapy
  • Kawaguchi et al. have reported that IANAC with cisplatin followed by radical hysterectomy or radiotherapy afforded similar results to concurrent chemoradiotherapy for stage IIIB cervical cancer (Kawaguchi et al., World Journal of Oncology, 2013, 4(6):221-229).
  • Drugs approved for use in the United States for the treatment of cervical cancer include bevacizumab, bleomycin, and topotecan hydrochloride, and the combination gemcitabine-cisplatin.
  • Uterine cancer of endometrial origin may be treated with, for example, megestrol acetate. But many systemic side effects of chemotherapeutic agents can result from current treatment methods. It is desirable to have a specific means of targeting uterine tumors.
  • colorectal cancer is the fourth most common cancer diagnosed each year for all adults combined. Separately, it is the third most common cancer in men and third most common cancer in women. In 2016, an estimated 134,490 adults in the United States were diagnosed with colorectal cancer, with 95,270 new cases of colon cancer and 39,220 new cases of rectal cancer. It is estimated that 49,190 deaths (26,020 men and 23,170 women) were attributed to colon or rectal cancer in 2016. Colorectal cancer is the second leading cause of cancer death in the United States, although when it is detected early, it can often be cured. The death rate from this type of cancer has been declining since the mid-1980s, probably because of an improvement in early diagnosis. The 5-year survival rate colorectal cancer is 65%, while the 10-year survival rate is 58% (http://www.cancer.net/node/18707).
  • Drugs approved for use in treating colon cancer in the United States include bevacizumab, irinotecan hydrochloride, capecitabine, cetuximab, ramucirumab, oxaliplatin, 5-FU, fluorouracil, leucovorin calcium, trifluridine, tipiracil hydrochloride, oxaliplatin, panitumumab, ramucirumab, regorafenib, ziv-aflibercept and the combinations capox, folfiri-bevacizumab, folfiri-cetuximab, FU-LV, xeliri and xelox.
  • the method comprises: a) first administering a course of radiation therapy targeting an area including a solid tumor; b) second waiting a period of time for the radiation to take effect on the vasculature in the area; and c) third administering a therapeutically effective dose of a chemotherapeutic agent to an isolated arterial section near the solid tumor.
  • the method comprises: a) first administering a targeted dose of radiation to an area including a solid tumor; b) second waiting a period of time; c) third isolating an area containing a cancerous tumor by, for example, isolating an arterial segment proximate to the tumor; and d) fourth administering a localized therapeutically effective dose of a chemotherapeutic agent.
  • the method comprises: a) administering a course of radiation therapy to an area including a solid tumor; b) isolating the proximal and the distal part of the vasculature closest to the tumor to produce an isolated arterial segment; c) decreasing the intraluminal pressure of the isolated arterial segment to the level of the interstitium; and d) administering a therapeutically effective dose of a chemotherapeutic drug.
  • the method comprises an additional step of waiting a period of time following the step of administering the course of radiation therapy.
  • the method includes delivering radiation therapy to a target area including a tumor; and inserting a catheter device into an artery where the catheter device includes a first occlusion member, a second occlusion member, and a body defining a lumen in fluid communication with an infusion port.
  • the infusion port is disposed between the first occlusion member and the second occlusion member.
  • the first occlusion member and the second occlusion member are moved to an area of the artery disposed proximate to the target area.
  • the first occlusion member and the second occlusion member are deployed to isolate the area of the artery disposed proximate to the target area.
  • a dose of chemotherapeutic agent is then delivered to the isolated area of the artery via the lumen and the infusion port.
  • the chemotherapeutic agent permeates to the target area including the tumor from the isolated area of the artery.
  • the method includes administering a dose of radiation to a target area including a tumor; inserting a catheter device into a vessel, the catheter device including a first occlusion element and a second occlusion element; isolating a segment of the vessel proximate to the target area using the first occlusion element and the second occlusion element; and delivering a dose of an agent to the segment via the catheter device.
  • the method includes administering a dose of radiation to a target area including a tumor; isolating a segment of the vessel proximate to the target area; adjusting an intraluminal pressure of the segment to a level of pressure of an interstitial space between the vessel and the target area; and delivering a dose of an agent to the segment via the catheter device.
  • FIG. 1 is an illustration of a catheter device disposed within a vessel, according to an embodiment.
  • FIG. 2 is a flowchart illustrating a method for treating a cancerous tumor, according to embodiments described herein.
  • FIG. 3 is a graph showing a change in pressure (mmHg) in a vessel over time while undergoing treatment, according to an embodiment.
  • FIG. 4A is schematic illustration of a catheter device shown in a dilated configuration disposed within a vessel, according to an embodiment.
  • FIG. 4B is a schematic illustration of dispersal of an infused agent into tissue surrounding a vessel, according to an embodiment.
  • FIG. 5 is a flowchart illustrating a method for treating a cancerous tumor, according to embodiments described herein.
  • FIG. 6A is an illustration of dispersal of an infused agent into tissue surrounding a vessel without application of radiation therapy
  • FIG. 6B is an illustration of dispersal of an infused agent into tissue surrounding a vessel with application of radiation therapy, according to embodiments described herein.
  • FIG. 7 is an image of a pancreatic tumor after undergoing treatment according to methods described herein.
  • FIG. 8 is an image showing penetration of infused agents into tissue surrounding a vessel via the microvasculature, according to an embodiment.
  • FIG. 9 is a graph comparing survival rates of patients treated according to different methods described herein.
  • FIG. 10 is a bar chart comparing survival rates of patients treated according to different methods described herein.
  • FIG. 11 is an image of a catheter device disposed in a vessel in a patient's groin area, according to an embodiment.
  • FIG. 12 is an image showing penetration of an infused agent into tissue surrounding a vessel after undergoing treatment, according to an embodiment.
  • chemotherapeutic is intended to mean a single chemotherapeutic or a combination of chemotherapeutics
  • course of radiation therapy is intended to mean one or more courses of radiation therapies, or combinations thereof
  • agent is intended to mean a single agent or a combination of agents, and so on and so forth.
  • proximal and distal refer to direction closer to and away from, respectively, an operator (e.g., surgeon, physician, nurse, technician, etc.) who would insert the medical device into the patient, with the tip-end (i.e., distal end) of the device inserted inside a patient's body first.
  • the implant end first inserted inside the patient's body would be the distal end of the implant, while the implant end to last enter the patient's body would be the proximal end of the implant.
  • Treatment refers to reducing the frequency of symptoms of cancer (including eliminating them entirely), avoiding the occurrence of cancer, and/or reducing the severity of symptoms of cancer.
  • “Therapeutically effective amount” and “therapeutically effective dose” means the amount or dosage of a compound that, when administered to a patient for treating cancerous tumors, is sufficient to effect such treatment.
  • the “therapeutically effective amount” or “therapeutically effective dose” will vary depending on, for example, the compound, the size of the tumor, and the age, weight, etc., of the patient to be treated.
  • the present application provides a method for treating or ameliorating solid cancerous tumors, wherein a course of targeted radiation therapy is first administered to an area including one or more tumors. A period of time is allowed to elapse in order for the radiation to take effect in down-sizing the tumor(s). The radiation may also reduce the microvasculature in the tissue in the area including the tumor(s). This period is followed by the administration of a therapeutically effective amount of a chemotherapeutic agent to an isolated arterial section near the solid tumor. Isolation of the arterial section may be accomplished by isolating the proximal and the distal part of the vasculature closest to the tumor whereby the intraluminal pressure is then decreased to the level of the interstitium. The therapeutically effective dose of the chemotherapeutic agent may then be administered via infusion. Combination of radiation therapy followed by properly administered chemotherapy is complementary and has a synergistic clinical effect when combined.
  • Intra-arterial delivery of chemotherapy has been shown to be effective and safe in treatment of certain solid tumors.
  • a prerequisite for effective TAC or TACE is the selective engagement of nearby arterial vessels and, more commonly, the vessels feeding the tumor itself.
  • the precise engagement of the feeding or branch vessel remains a major limitation for expanding the use of TACE and TAC in solid tumors, including but not limited to, pancreatic adenocarcinoma.
  • the isolation of the artery supplying the tumor or the relevant tissue can be a technical challenge for a number of reasons, for example: a) there are organs with no dedicated single blood vessel supplying those specific organs; b) side and terminal branches of an artery can cause collateral flow to tissues and organs beyond the area of interest; and c) the tumor feeder vessels may be too small for detection by angiography; and d) the feeding branch/artery cannot be cannulated.
  • methods disclosed herein may involve administering radiation therapy to an area including a tumor.
  • the radiation may reduce the microvasculature in the tissue in the area including the tumor.
  • the proximal and the distal part of the vasculature e.g., an artery
  • Both the side and the terminal branches are excluded, which prevents drug washout.
  • the reduced microvasculature in the tissue in the area also reduces drug washout.
  • the intra-luminal pressure is reduced to the level of interstitium (typically, 10-20 mmHg).
  • a therapeutic agent such as, for example, a chemotherapeutic drug
  • a chemotherapeutic drug can be infused into the isolated arterial segment.
  • the pressure gradient forces the infused agent to traverse the arterial wall and enter the surrounding tissue, especially the vasa vasorum surrounding the vessel wall, with subsequent influx of the therapeutic agent into the tissue.
  • This technique is referred to herein as “trans-arterial micro-perfusion” or TAMP.
  • TAMP is not dependent on angiographic identification and cannulization of the tumor arterial supply or feeding vessels and thus overcomes deficiencies of current techniques.
  • the drug traverses the arterial wall (e.g., endothelium and media) before entering into the adventitia and interstitium.
  • the interstitial concentration achieved is dependent on both the influx of the drug into the tissue across the artery wall and the efflux of the drug out of the interstitium via capillaries in the tissue area and the venous system.
  • the infusion parameters that determine the influx of the drug via TAMP include, but are not limited to, the intraluminal pressure achieved between the balloons, the intraluminal drug concentration, and the duration of infusion. By varying these parameters, one can change the drug influx and interstitial concentration.
  • FIG. 1 depicts an example catheter device 100 .
  • the catheter device 100 includes a first occlusion element 102 and a second occlusion element 104 .
  • the occlusion elements 102 , 104 can be any suitable devices or mechanisms that are configured to selectively limit, block, obstruct, or otherwise occlude a bodily lumen (e.g., artery) in which the occlusion elements 102 , 104 are disposed.
  • the occlusion elements 102 , 104 can be inflatable balloons or the like that can be transitioned between a collapsed (e.g., deflated) configuration and an expanded (e.g., inflated) configuration.
  • the first occlusion element 102 can be coupled to a distal end portion of a first catheter, and the second occlusion element 104 can be coupled to the distal end portion of a second catheter.
  • the first occlusion element 102 and the second occlusion element 104 can be coupled to a single catheter at different points along the catheter.
  • the catheter device 100 can be used to isolate a segment 120 of a bodily lumen (e.g., artery) within the space defined between the first occlusion element 102 and the second occlusion element 104 .
  • a procedure can be performed within the isolated segment 120 such as, for example, delivering a therapeutic agent to the isolated segment 120 and surrounding tissue 110 .
  • FIG. 2 illustrates a method 200 for performing a TAMP procedure.
  • the method includes introducing a catheter (e.g., the catheter device 100 ) into a mammalian body into a bodily lumen (e.g., artery), at 202 .
  • the catheter can be advanced to a target area, at 204 , and used to isolate the target area, at 206 .
  • the catheter can include two occlusion members (e.g., occlusion elements 102 , 104 ) that can be deployed (e.g., inflated) to isolate a segment of the bodily lumen to exclude the segment from its side and terminal branches.
  • occlusion members e.g., occlusion elements 102 , 104
  • a first occlusion member e.g., a distal occlusion element
  • a second occlusion member can be inflated (e.g., a proximal occlusion element), at 208 .
  • an agent can be injected through an injection port of the catheter device to the isolated segment disposed between the two occlusion members, at 210 .
  • a contrast dye can be can be injected into the isolated segment and the surrounding area can be visualized to determine whether the segment has been correctly isolated. For example, the injection of contrast through the infusion port can ensure that no extra vessels or bodily lumens are included in the isolated area.
  • the catheter can be moved and the procedure repeated until the clinician can confirm that the catheter is correctly positioned. After the positioning of the catheter is confirmed, a therapeutic cell/biologic/agent can be introduced to the isolated segment through the infusion port.
  • FIG. 3 graphically illustrates how pressure (mmHg) in a bodily lumen (e.g., artery) changes over time as a TAMP procedure is performed (e.g., method 200 ).
  • a TAMP procedure e.g., method 200
  • the pressure in the bodily lumen drops when a first balloon or occlusion element is inflated and continues to drop until a second balloon or occlusion element is inflated.
  • the pressure then increases when an agent (e.g., a contrast dye, a therapeutic agent) is infused into the segment isolated by the first balloon and the second balloon.
  • an agent e.g., a contrast dye, a therapeutic agent
  • FIGS. 4A and 4B schematically depict an example of a catheter device 300 disposed within a bodily lumen 310 (e.g., artery) and the dispersal of an infused agent 360 through the bodily lumen 310 into surrounding tissue.
  • the infused agent 360 can be injected into an isolated segment 320 and allowed to infuse into the surrounding tissue via, for example, a concentration gradient.
  • the infused agent 360 can infuse through a wall 312 of the bodily lumen 310 into the surrounding tissue.
  • the concentration of the agent 360 decreases as the distance (shown in millimeters (mm)) from the isolated segment 320 of the bodily lumen 310 increases.
  • the drug concentration near an isolated segment of a bodily lumen may be advantageously increased.
  • the increased concentration can increase the effect of the chemotherapeutic drug on the tumor.
  • One technique that can decrease tissue efflux is to radiate the tissue prior to treatment. Radiation can decrease tissue microvasculature in tissue containing cancerous tumors. Thus, combining prior radiation to decrease tissue microvasculature with TAMP can have a synergistic effect.
  • Methods described herein can be used to treat solid cancerous tumors arising from any organ of the body where the tumor has its own or a proximate blood supply provided by a bodily lumen (e.g., artery) that can be isolated.
  • a bodily lumen e.g., artery
  • cancers that can be treated using methods described herein can be, but are not limited to, pancreatic cancer, lung cancer, liver cancer, uterine cancer, colon cancer, or brain cancer.
  • apparatuses and methods described herein can be used to isolate a targeted region in a patient's pancreas.
  • a course of radiation prior to TAMP treatment has significant clinical benefit in patients with locally advanced pancreatic cancer. Combining these two modalities led to a significant increase in median survival, a reduction of tumor markers, and downsizing of the tumor.
  • a similar combination therapy administered by methods described herein may have clinical benefit in solid tumors in other organs and tissue areas where TAMP may be considered as a treatment option.
  • Such tumors include, but are not limited to, pancreatic tumors, lung tumors, brain tumors, liver tumors, uterine tumors, and colon tumors.
  • a method of treating a cancerous tumor can involve: first administering a course of radiation therapy targeting tissue including a solid cancerous tumor; second waiting a period of time for the destructive effect of the radiation on the vasculature to take effect; and third administering a therapeutically effective dose of a chemotherapeutic agent to an isolated section of a bodily lumen near the solid tumor.
  • the targeted solid tumor can be, for example, a pancreatic tumor, a lung tumor, a brain tumor, a liver tumor, a uterine tumor, or a colon tumor.
  • the administration of radiation on the targeted tissue area can include, for example, delivering approximately 20 to 50 Gy of radiation over approximately one to five weeks in approximately one to 25 sessions.
  • the period of time between administration of the radiation therapy and administration of the chemotherapeutic agent can be selected to maximize the devascularization of the tissue surrounding the tumor. Depending on various factors including the specific course of radiation and the specific tissue area or organ, this period of time can be, for example, approximately one to six months, as short as two weeks, or as long as six months.
  • chemotherapeutic agents include doxorubicin, erlotinib hydrochloride, everolimus, 5-FU, flurouracil, folfirinox, gemcitabine hydrochloride, gemcitabine-cisplatin, gemcitabine-oxaliplatin, irinotecan hydrochloride liposome, leucovorin, mitomycin C, mitozytrex, mutamycin, oxaliplatin, paclitaxel, paclitaxel albumin-stabilized nanoparticle formulation, or sunitinab malate or a combination of these drugs.
  • the section of the bodily lumen near the cancerous tumor can be isolated by the use of a catheter device to deliver the chemotherapeutic agent.
  • the catheter device can be used to increase the intraluminal pressure in the isolated section of the bodily lumen to achieve increased tissue penetration.
  • a method of treating a cancerous tumor can involve: first administering a targeted dose of radiation to tissue including a solid tumor; second waiting a period of time; third isolating an area containing a cancerous tumor; and fourth administering a localized therapeutically effective dose of a chemotherapeutic agent.
  • the targeted solid tumor may be, for example, a pancreatic tumor, a lung tumor, a brain tumor, a liver tumor, a uterine tumor, or a colon tumor.
  • the administration of radiation on the targeted tissue area can include, for example, delivering approximately 20 to 50 Gy of radiation over approximately one to five weeks in approximately one to 25 sessions.
  • the period of time between administration of the radiation therapy and administration of the chemotherapeutic agent can be selected to maximize the devascularization of the tissue surrounding the tumor. Depending on various factors including the specific course of radiation and the specific tissue area or organ, this period of time can be, for example, at least a month.
  • the isolated area can be, for example, an artery that is in proximity to the tumor.
  • a catheter device can be used to isolate the area.
  • the catheter device can be used to increase the intraluminal pressure in the isolated artery.
  • the isolated area can be, for example, the area of tissue involving the tumor.
  • chemotherapeutic agents include doxorubicin, erlotinib hydrochloride, everolimus, 5-FU, flurouracil, folfirinox, gemcitabine hydrochloride, gemcitabine-cisplatin, gemcitabine-oxaliplatin, irinotecan hydrochloride liposome, leucovorin, mitomycin C, mitozytrex, mutamycin, oxaliplatin, paclitaxel, paclitaxel albumin-stabilized nanoparticle formulation, or sunitinab malate or a combination of these drugs.
  • a method of treating a cancerous tumor can involve: administering a course of radiation therapy to tissue including a solid tumor; isolating the proximal and the distal part of the vasculature closest to the tumor to produce an isolated arterial segment; decreasing the intraluminal pressure of the isolated arterial segment to the level of the interstitium; and administering a therapeutically effective dose of a chemotherapeutic drug.
  • the course of the radiation therapy can decrease tissue efflux of the chemotherapeutic drug.
  • the vasculature can be isolated using a double balloon catheter positioned to exclude both the side and terminal branches of the artery.
  • the chemotherapeutic drug can pass across the artery wall and into the surrounding tissue via a pressure gradient generated by the increase in the intraluminal pressure above the interstitial pressure.
  • the method can additionally include waiting a period of time following the step of administering the course of radiation therapy.
  • the period of time between administration of the radiation therapy and administration of the chemotherapeutic agent can be selected to maximize the devascularization of the tissue surrounding the tumor. For example, depending on various factors including the specific course of administering the radiation therapy and the specific tissue region, this period of time can be at least two weeks.
  • the targeted solid tumor can be, for example, a pancreatic tumor, a lung tumor, a brain tumor, a liver tumor, a uterine tumor, or a colon tumor.
  • the chemotherapeutic drug can be, for example, a single chemotherapeutic or a combination of chemotherapeutic drugs.
  • FIG. 5 is a flowchart illustrating a method 500 of treating a tumor involving the use of radiation.
  • the method involves administering a course of radiation therapy to a target area, at 502 .
  • an amount of radiation e.g., 20-50 Gy
  • the target area can be a tissue area including a tumor.
  • the method then optionally includes waiting a period of time for the radiation therapy to devascularize the tissue in the target area, at 504 .
  • the method 500 further includes introducing a catheter (e.g., the catheter device 100 ) into a mammalian body into a bodily lumen (e.g., artery), at 506 .
  • the catheter can be advanced to a target area, at 508 , and used to isolate the target area, at 510 .
  • the catheter can include two occlusion members (e.g., occlusion elements 102 , 104 ) that can be deployed (e.g., inflated) to isolate a segment of the bodily lumen to exclude the segment from its side and terminal branches.
  • an agent can be injected through an injection port of the catheter device to the isolated segment disposed between the two occlusion members, at 512 .
  • a contrast dye can be can be injected into the isolated segment and the surrounding area can be visualized to determine whether the segment has been correctly isolated. For example, the injection of contrast through the infusion port can ensure that no extra vessels or bodily lumens are included in the isolated area.
  • the catheter can be moved and the procedure repeated until the clinician can confirm that the catheter is correctly positioned. After the positioning of the catheter is confirmed, a therapeutic cell/biologic/agent can be introduced to the isolated segment through the infusion port.
  • the step of administering the radiation therapy ( 502 ) can occur during and/or after the steps of introducing the catheter into the mammalian body ( 506 ), advancing the catheter to the target area ( 508 ), isolating the target area ( 510 ), and/or injecting a therapeutic agent into the target area ( 512 ).
  • one or more steps of the method 500 can be repeated before, during, and/or after other steps of the method 500 .
  • FIGS. 6A and 6B schematically illustrate the effects of radiation on the vasa vasorum microvasculature in tissue surrounding an isolated segment 620 of a bodily lumen 610 .
  • the radiation therapy reduces drug washout and increases drug tissue concentration when a drug is delivered to the area using methods described herein, such as, for example, TAMP.
  • FIG. 6A depicts an area of tissue surrounding an isolated segment 620 of a bodily lumen 610 prior to radiation therapy.
  • FIG. 6B depicts the area of tissue after radiation therapy.
  • the number of microvasculature connections 632 (e.g., micro-vessels extending from the isolated section 620 to the venous system 630 ) is reduced, thereby allowing a greater concentration of an infused drug 660 to remain in the tissue area.
  • a catheter device 600 can be used to deliver the infused drug 660 to the target area.
  • the catheter device 600 can be similar to other catheter devices described herein (e.g., catheter device 100 and catheter device 300 ).
  • the catheter device 600 has a first occlusion element 602 and a second occlusion element 604 , which are coupled to distal end portions of a first catheter 601 and a second catheter 603 , respectively.
  • the catheter device 600 also includes a port 605 for delivering the infused drug 660 to the isolated segment 620 between the first occlusion element 602 and the second occlusion element 604 . Once the infused drug 660 is delivered to the isolated segment 620 , it can pass through a wall 612 of the bodily lumen 610 into surrounding tissue.
  • radiation therapy can include, for example, external-beam radiation therapy delivered by X-rays, gamma rays, proton beams, or other appropriate sources. Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide. While both healthy and cancerous cells are damaged by radiation therapy, the goal of radiation therapy is to destroy as few normal, healthy cells as possible.
  • the radiation therapy described herein can be targeted as narrowly as possible to the solid tumor(s) being treated or the tissue closely surrounding the solid tumor(s).
  • a radiation treatment plan is individualized for a patient, based upon detailed imaging scans showing the location of a patient's tumor(s) and the normal areas around it.
  • CT Computed tomography
  • MRI magnetic resonance imaging
  • PET positron emission tomography
  • ultrasound scans may also be used.
  • a radiation oncologist determines the exact area that will be treated, the total radiation dose that will be delivered to the tumor, how much dose will be allowed for the normal tissues around the tumor, and the safest angles (paths) for radiation delivery.
  • Radiation doses for cancer treatment are measured in Gy, which is a measure of the amount of radiation energy absorbed by one kilogram of human tissue. Different doses of radiation are needed to kill different types of cancer cells. Patients can receive external-beam radiation therapy in daily treatment sessions over the course of several weeks. The number of treatment sessions depends on many factors, including the total radiation dose that will be given. For example, one dose, which constitutes a fraction of the total planned dose of radiation, can be given each day. In a different instance, two treatments a day can be given.
  • the course of radiation therapy appropriate for use in the method of the present invention will depend on the specific cancerous tumor being treated.
  • the specific dose of radiation, the duration of the radiation, and the number of treatments for any particular individual will depend upon a variety of factors including the type of cancer, the size of the tumor(s), and the patient's age and medical history including, for example, the amount of radiation previously received.
  • Concurrent chemotherapy may also impact the dose of radiation given.
  • the course of radiation therapy can be approximately 20 to 50 Gy of radiation delivered in approximately one to 25 treatments over approximately one to five weeks. Alternatively, two to five sessions of radiation can be given over a period of approximately a week.
  • the amount of radiation therapy delivered may be as low as one Gy.
  • the course of radiation therapy can be approximately 40 to 50 Gy of radiation delivered in approximately 22 to 25 treatments over approximately four to five weeks.
  • the amount of radiation therapy useful in methods described herein is that necessary to devascularize the solid tumor of interest thus allowing the TAMP technique to be used advantageously.
  • a physician may wait for a period of time before administering chemotherapy such that the tumorous tissue can die (e.g., necrosis) or become devascularized.
  • this period of time can be selected to maximize devascularization of the solid tumor and/or tissue containing the solid tumor.
  • this period of time can be selected to maximize the effect of the chemotherapy based on a sufficient amount of devascularization.
  • the time period that elapses before administering chemotherapy can be at least a month. In other instances, the period of time is approximately two weeks to six months.
  • chemotherapeutics can be selected based on the particular solid cancerous tumor that is to be treated.
  • the following chemotherapeutic agents and others may be used in the treatment of pancreatic cancer: doxorubicin, erlotinib hydrochloride, everolimus, 5-FU, flurouracil, folfirinox, gemcitabine hydrochloride, gemcitabine-cisplatin, gemcitabine-oxaliplatin, irinotecan hydrochloride liposome, leucovorin, mitomycin C, mitozytrex, mutamycin, oxaliplatin, paclitaxel, paclitaxel albumin-stabilized nanoparticle formulation, or sunitinab malate.
  • a combination of agents may be employed.
  • a combination of gemcitabine hydrochloride (Gemzar®) and paclitaxel albumin-stabilized nanoparticle formulation (Abraxane®) may be used.
  • chemotherapeutic agents are available from a variety of corporate sources licensed to provide such agents for human use.
  • Generic formulations of non-proprietary chemotherapeutics are typically available from a variety of manufacturers.
  • a list of these licensed suppliers is available from the U.S. Food and Drug Administration's “Approved Drug Products with Therapeutic Evaluations,” commonly known as the “Orange Book” (http://www.accessdata.fda.gov/scripts/cder/ob/).
  • Proprietary chemotherapeutics are typically available from one manufacturer, also identifiable in the Orange Book.
  • the corporate source for Gemzar® is Eli Lilly and Company (Indianapolis, Ind.) and Celgene Corporation (Summit, N.J.) supplies Abraxane®.
  • Methods described herein can use an amount of chemotherapeutic agent that is known to be therapeutically effective at treating a tumor.
  • the amount of chemotherapeutic agent that is used can be based on the Prescribing Information for a particular chemotherapeutic drug.
  • a physician can adjust the amount of the chemotherapeutic agent to an amount that is appropriate for use with the TAMP techniques described herein.
  • a therapeutic agent e.g., chemotherapy drug
  • rapid infusion e.g., injected directly into an artery over a period of minutes
  • intravenous infusion e.g., through a drip or pump over a period of approximately 20 minutes to a few hours
  • continuous infusion e.g., through a continuation infusion pump over a period of weeks to months.
  • methods described herein can use a catheter device such as, for example, a double occlusion balloon to isolate a segment of a bodily lumen (e.g., artery) and allow infusion of a therapeutic agent (e.g., chemotherapy drug) into the isolated segment between the balloon after they are inflated.
  • a therapeutic agent e.g., chemotherapy drug
  • methods disclosed herein may use catheter devices such as those described in U.S. patent application Ser. No. 14/293,603, filed Jun. 2, 2014, titled “Devices, methods and kits for delivery of therapeutic materials to a target artery,” now issued as U.S. Pat. No. 9,457,171, and U.S. patent application Ser. No. 14/958,428, filed Dec.
  • a catheter device suitable for isolating a section of a bodily lumen near a solid tumor includes, but is not limited to, features and functions such as, for example: (1) selective isolation of the targeted portion of the portion of the artery for targeted delivery of the therapeutic agent to the solid tumor; (2) an infusion port allowing first, injection of contrast into the isolated segment to allow direct visualization of the origin of the branches of the artery supplying the cancerous tissue, and second, introduction of chemotherapeutic drugs; and (3) a self-contained assembly unit with easy retrieval after completion of the procedure.
  • the catheter device includes expandable occlusion elements in the form of inflatable balloons that can be used to isolate a proximal and distal end of a bodily lumen of interest.
  • Methods described herein can include, for example, introducing a catheter device into a splenic artery of the pancreas.
  • the catheter device can have, for example, two lumens—one for inflation/deployment of the balloons/occluding elements and a second for introduction of the infusate (e.g., therapeutic agent) to the space between the two balloons.
  • the catheter can be advanced to a target portion of the splenic artery. A region of the target portion of the splenic artery is selectively isolated and the infusate is injected into the isolated region.
  • the method can include advancing at least a portion of the catheter device to an ostium of a celiac artery, its hepatic branch (and its branches), or if necessary, the superior mesenteric artery, depending on a patient's anatomy.
  • a contrast dye is injected into the isolated region to confirm exclusion of side branches before injecting the infusate.
  • the catheter device can have one or more features to achieve a desired effect on a specific anatomy of tumors. For example, there may be: (1) a separate inflation lumen for the proximal and the distal occluders/balloons to allow different size occluders/balloons proximally and distally; (2) slidable catheters to allow the distance between the occluders/balloons to be adjusted; and (3) a sensor at the tip to monitor pressure in the isolated segment of the bodily lumen.
  • FIGS. 4A and 4B schematically depict an example of a catheter device 300 disposed within a bodily lumen 310 (e.g., artery) and the dispersal of an infused substance 360 through the bodily lumen 310 into surrounding tissue.
  • the catheter device 300 can be similar to other catheter devices (e.g., catheter device 100 ) described herein.
  • catheter device 300 includes a first occlusion element 302 and a second occlusion element 304 for occluding a portion 320 of bodily lumen 310 .
  • the first occlusion element 302 is coupled to a distal end portion of a first catheter 301
  • the second occlusion element 304 is coupled to a distal end portion of a second catheter 303 .
  • the occlusion elements 302 , 304 are filter elements that can be moved between a collapsed configuration for insertion of the catheter device 300 into a body of a patient (e.g., into an artery) and an expanded or dilated configuration, as shown in FIGS. 4A and 4B , for occluding a portion of a bodily lumen.
  • the occlusion elements 302 , 304 when in the collapsed configuration have a smaller outer perimeter (or diameter) than when in the expanded configuration.
  • the catheter device 300 can be used to isolate a segment 320 of a bodily lumen 310 within the space defined between the first occlusion element 302 and the second occlusion element 304 .
  • the catheter device 300 can include a lumen in fluid communication with port or opening 305 for delivering an agent 360 (e.g., a dye or a chemotherapy drug) to the space between the first occlusion element 302 and the second occlusion element 304 .
  • the first catheter 301 can define the lumen and the opening 305 .
  • the opening 305 can be disposed on the distal end portion of the first catheter 301 distal to the first occlusion element 302 .
  • the second catheter 303 can be movably disposed within a lumen defined by the first catheter 301 such that the second catheter 303 can be moved relative to the first catheter 301 to move the second occlusion element 304 relative to the first occlusion element 302 .
  • the second occlusion element 304 can be moved toward the first occlusion element 302 to increase pressure within the isolated segment 320 .
  • the increased pressure can be used, for example, to drive delivery of the agent 360 through the wall 312 of the bodily lumen 310 and into the surrounding tissue.
  • the catheter device 310 can have a sensor such as a pressure transducer 306 that may assist with achieving an optimal pressure within an occluded arterial segment for optimizing trans-arterial diffusion of an infused substance during a method of cancer treatment (e.g., a TAMP procedure).
  • the pressure transducer 306 may be disposed along the catheter device 300 in the isolated arterial segment 320 (e.g., disposed between the first occlusion element 302 and the second occlusion element 304 (as depicted in FIGS. 4A and 4B )).
  • the pressure transducer 306 can be disposed on one of the catheters 301 , 303 , or disposed on one of the occlusion elements 302 , 304 .
  • the pressure transducer 306 can be designed to measure an intraluminal pressure of the isolated segment 320 .
  • the pressure measurements may be used to adjust the intraluminal pressure of the isolated segment 320 to a predetermined or optimal pressure level.
  • a physician may use the pressure measurements to determine a rate of infusing a drug or other therapeutic material into the isolated segment 320 in order to decrease or increase the intraluminal pressure of the isolated segment 320 .
  • a physician can increase the rate of infusion of a drug to increase the intraluminal pressure of the isolated segment 320 above the pressure of tissue surrounding the isolated segment 320 (e.g., above the pressure of the interstitium) to create a pressure gradient between the intraluminal space and the surrounding tissue to increase permeation of the infused drug through the arterial wall and into the tissue.
  • a physician can increase or decrease the intraluminal pressure of the isolated segment 320 by adjusting the position of the two occlusion elements 302 , 304 relative to one another (e.g., moving the two occlusion elements 302 , 304 closer or further apart from one another).
  • the efficacy of the methods of the present invention in the treatment of solid cancerous tumors can be evaluated in human clinical trials conducted under appropriate standards and ethical guidelines as set forth by the U.S. Food and Drug Administration (FDA). Such studies are conducted according to U.S. and International Standards of Good Clinical Practice. Typically, such trials are comparison trials, in that the method of the present invention is utilized in one cohort of patients, while one or more other cohorts receive alternative methods of treating the tumors.
  • the alternative methods can include, for example, treatment with systemic chemotherapy alone.
  • a clinical trial for the treatment of cancerous tumors may have a primary objective of evaluating survival in patients who undergo radiation therapy followed by intra-arterial delivery of a chemotherapeutic agent to an isolated arterial section near the solid tumor after a suitable interval of time elapses.
  • the second objective of such a trial is to assess tumor response by known imaging techniques at the primary site of application of the chemotherapeutic agent.
  • the size of the tumor before and after treatment can be determined and evaluated across different treatment methods.
  • the conversion rate from unresectable or borderline resectable to potentially resectable or resectable tumors can be determined.
  • the results may be analyzed using standard statistical techniques known to those skilled in the art.
  • FIG. 7 is an image 700 of a pancreatic tumor 710 of a pig after treatment with the TAMP method.
  • the method involved occluding the celiac artery of the pig with a double balloon catheter, rapidly infusing dye at six milliliters per minute for ten minutes into the isolated segment of the celiac artery, and harvesting the tissue next to the celiac artery. As depicted, the infused dye has permeated into the harvested tissue.
  • FIG. 8 is an image 800 of tissue surrounding the celiac artery of a pig after treatment with the TAMP method.
  • the method involved occluding the celiac artery of the pig with a double balloon catheter (i.e., a balloon catheter with occlusion elements or balloons 802 ) and rapidly infusing dye at six milliliters per minute for ten minutes into the isolated segment of the celiac artery.
  • the image shows the tissue surrounding the celiac artery in situ within ten sections after initiating the rapid infusion of the dye.
  • the dye 804 has penetrated into the surrounding tissue via the vasa vasorum microvasculature.
  • FIGS. 11 and 12 relate to an experiment conducted on a pig to evaluate the effect of radiation on tissue penetration of drugs/molecules using the TAMP technique.
  • the experiment involved administering radiation treatment to a left groin area in a pig and comparing the penetration of a dye introduced using the TAMP technique in the left groin area (referred to herein as the test 1200 ) versus the penetration of the dye in the right groin area (referred to herein as the control 1210 ).
  • a Yucatan pig was anesthetized for a CT scan of the femoral artery to plan the radiation treatment. Both femoral arteries were accessed for the placement of sterile gold fiducial markers to mark the areas of interest for comparison following the radiation treatment and infusion of dye.
  • FIG. 11 depicts an image 1100 of the left groin area with the gold marker 1106 .
  • the catheter 1110 isolated the relevant segment of the left femoral artery adjacent to the gold fiducial marker 1106 to ensure exclusion of any large side branches and to achieve optimal intravascular pressure in the isolated segment.
  • a syringe pump was then used to inject a dye at six milliliters per minute for approximately 30 seconds through an infusion port between the two balloon catheters.
  • the same procedure was repeated for the right femoral artery.
  • the area of dye penetration around the blood vessels were measured. As shown in FIG. 12 , there was approximately a three-fold increase in penetration on the irradiated left side (i.e., test 1200 ) as compared to the control right side (i.e., control 1210 ).
  • eligible patients underwent selective catheterization introduced via the femoral artery into the celiac axis into the splenic, hepatic and/or superior mesenteric artery(ies) using the TAMP technique as described above for the localized delivery of gemcitabine followed by embolization agent lipiodol.
  • An interventional radiologist used the RenovoCathTM RC 120 catheter to optimize drug delivery to the tumor(s).
  • the femoral artery arteriotomy was sealed and patient monitored as per standard institutional protocol.
  • FIG. 9 shows the superiority of the TAMP technique as compared to standard systemic chemotherapy.
  • Graph 900 shows the increase in survival benefits in patients treated with TAMP compared to those treated with a systemic intravenous infusion of the same drug (i.e., gemcitabine).
  • Line 902 represents the survival percentage of patients completing eight treatments of gemcitabine using the TAMP technique.
  • Line 904 represents the survival percentage of patients completing more than two treatments of gemcitabine using the TAMP technique.
  • line 906 represents the survival percentage of patients given systemic infusion of gemcitabine, the results of which are taken from Sullivanrt et al., Ann. Oncol., 2008, 19:1592-9.
  • the survival rates of the patients treated with the TAMP technique i.e., lines 902 , 904
  • were greater than the survival rates of the patients given systemic infusion of the same drug i.e., line 906 ).
  • FIG. 10 is a graph 1000 illustrating the effect of the TAMP technique on patient survival after radiation therapy compared with the effect of the TAMP technique with no radiation therapy.
  • Fifteen patients with locally advanced pancreatic cancer were treated with gemcitabine in a dose-escalated protocol administered in four cycles using the TAMP technique. Each cycle consisted of two treatments two weeks apart.
  • the efficacy data for the fifteen patients who received more than one cycle of TAMP treatment are shown in FIG. 6 . Of these fifteen patients, five had no prior treatment of any kind, five had prior systemic chemotherapy, and five received radiation in additional to systemic chemotherapy prior to entering the study. On average, patients received radiation one to six months prior to enrolling in the study and receiving TAMP therapy.
  • the most pronounced survival benefit was seen in patients who had received radiation prior to the initiation of TAMP therapy. Specifically, patients with prior radiation had a significant improvement in survival compared to the ones that had either no prior treatment or only prior systemic chemotherapy with no radiation therapy. Patients were treated with TAMP therapy, regardless of their prior history.
  • the dotted portion of the bars ( 1020 , 1030 ) indicates the average time from diagnosis to the first TAMP therapy, while the clear portion of the bars ( 1010 , 1022 , 1032 ) indicates the average time from the first TAMP therapy to death.

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